Market Access National Accounts, Associate Director

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Position Overview

The Market Access National Accounts, Associate Director is responsible for leading the relationship with national and regional payors, laboratory benefit managers, and government accounts such as VA, DoD, and state Medicaid.  The position is responsible for establishing medical policy coverage for the company’s portfolio of products within their assigned accounts and geography.  The position is responsible for establishing cross-functional collaboration with key stakeholders such as Access Strategy, Medical, Clinical, etc. in order to ensure payor gaps in coverage are identified and understood so strategy and tactics can be developed to ensure proper evidence generation to support driving positive medical policy.  This includes but is not limited to evaluating the evidence that competitive tests have developed, published, and used to gain coverage at payors and lab managers; updates to NCCN and professional society guidelines/consensus statements; and how newly published data for our tests can be incorporated into product dossiers and other medical communications.  

The position is responsible for developing and implementing contracting strategies that are in alignment with the Business Unit’s pricing philosophy.  This includes exploring and evaluating alternative contracting strategies like value-based agreements, capitation, tiered discounts, risk share, etc.  Position is responsible for developing and implementing strategies and tactics that lead to the removal of any prior authorizations that the company’s PO products may be subject to.  The position is also responsible for revenue pull through support through active collaboration with their billing and reimbursement triad team.  In addition, the position is responsible for providing technical and/or administrative product information related to requests for proposals from organizations within assigned geography. 

Essential Duties

Include but are not limited to the following:

• Serve as the principal contact and manage complex national and regional payers, laboratory benefit managers, as well as government entities such as VA, DoD, and state Medicaid programs, striving to secure coverage, leading contract negotiations and working with cross-functional departments to bring the process to closure.
• Establish medical policy coverage for the company’s portfolio of tests within assigned national and regional accounts, laboratory benefit managers, state Medicaid programs, and VA/DoD facilities.
• Establish cross-functional relationships and collaboration with key stakeholders such as Access Strategy, Medical Affairs, Clinical Development, HEOR, etc. to ensure payor gaps in coverage are identified and understood so strategy and tactics are developed to ensure proper evidence generation to support obtaining positive medical policy coverage.
• Develop, maintain, and grow disease state knowledge required to understand and analyze medical polices.
• Assume role of subject matter expert as it relates to payor and lab manager medical policies.  This includes but is not limited to: utilizing all available resources to determine if there’s more than one policy we can obtain coverage through, knowledge of which tests are covered, criteria when testing is considered medically necessary, analyzing policies to identify evidence gaps hindering coverage or opportunities to expand coverage (new indications or removing unfavorable coverage criteria), working with internal stakeholders to educate them on what is hindering coverage, working with internal resources to develop appropriate materials and/or responses to address what is hindering coverage.
• Monitoring updates to NCCN and professional society guidelines/consensus statements. Working with cross-functional departments to ensure updates are incorporated into dossiers and all appropriate medical communications with payors, lab managers, and state Medicaid programs.
• Manage relationships with existing contracted insurance companies. Expand cast of characters to identify and develop working relationships with key Medical Policy personnel such as Medical Policy Medical Directors, Medical Policy Analysts, and others in the orbit of the medical policy committee, develop and maintain working relationships with key contracting and network contacts, identify key individuals responsible for implementing and measuring success of oncology related quality programs.
• Lead cross-functional development and implementation of strategies will lead to successful acceptance of Exact Sciences testing into payer medical policy guidelines.
• Remove prior authorizations and other burdens to testing (medical record requirement) wherever possible.
• Create product specific pull through pieces for ROLs to use in field, when contractual language doesn’t prohibit.   
• Maximize reimbursement by negotiating the highest possible reimbursement rates with national and regional payors, state fee schedules for Medicaid HMOs and managed Medicaid lines of business.  Develop and present business case to pricing committee when best negotiated rates fall outside approved pricing grid. 
• Identify new opportunities for contracting as the portfolio continues to expand.  Examples include risk-based contracting, capitation, etc.
• Work with triad team or Market Access Liaison on: revenue pull through initiatives as they arise, resolve payor/LBM prior authorization issues, update appropriate billing spreadsheets upon completion of new agreements, assist Revenue Cycle Team on payor / LBM issues as they arise.
• Incorporate tests/portfolio into oncology value programs that payors and/or lab managers may be utilizing (oncology medical homes, pathways, and accountable care organizations) to manage oncology spend.
• Stay up to date on trends in the commercial payer, lab management, and Medicaid market and develop strategy with senior management to address the changes and maintain acceptable reimbursement rates.
• Leverage state biomarker laws and incorporate into policy requests when appropriate to help gain coverage. Work with Market Access legal counsel to assess potential legal risk in the context of contract provisions; prepare letters of agreement and key contract provisions.
• Attend conferences and physician meetings related to payers and provide expertise to the Market Access team and internal stakeholders.
• Act in a leadership capacity for the Market Access team working closely with headquarters teams to develop and implement customer strategies and monitor projects supporting field pull through of account wins, collaborating closely with the functional VPs and the Director of Market Access Strategy.
• Ability to work independently with little direction. Ability to prioritize work based on policy review dates, number of lives, Business Unit priorities, etc.
• Capacity to research and stay current on managed care and healthcare industry trends.
• Effective English communication skills, both written and verbal.
• Effective presentation skills: ability to speak confidently to all levels of an organization and present ideas to customers in a way that produces understanding and impact.
• Outstanding influencing, interpersonal, and networking skills to drive successful relationship building.
• Outstanding problem solving, project, and program management skills.
• Apply effective time management, expense reporting, prioritization, and delegation skills.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
• Support and comply with the company’s Quality Management System policies and procedures.
• Attend work regularly and reliably.
• Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
• Ability and means to travel between Exact Sciences locations.
• Ability to travel 10% of working time away from work location, may include overnight/weekend travel.

Minimum Qualifications

• Bachelor’s Degree in Life Sciences, Nursing, Public Health, Business, Healthcare Administration, or related field.
• 8+ years of experience in any of the following areas: payer, contracting and coverage with large national payers; sales leadership in biotech, device, or diagnostic laboratory companies.
• Possess existing relationships with individuals at insurance companies and a variety of payer organizations, state, commercial, and Medicare organizations.
• Possess a solid understanding of the molecular diagnostic testing market: products, companies, and technology.
• Demonstrated success developing and managing complex negotiations with multiple decision makers.
• Demonstrated success developing a value proposition and effective business case that will influence medical policy.
• Possession of a valid driver's license, no more than two moving violations in the past 36 months, and no unresolved license revocation or suspension issues. 
• Authorization to work in the United States without sponsorship.
• Demonstrated ability to perform the Essential Duties of the position with or without accommodation.

Preferred Qualifications

• Demonstrated success leading field sales teams, specialty markets.
• Demonstrated track record of developing and managing complex negotiations with multiple decision makers.
• Ability to develop a value proposition and effective business case that will influence medical policy.
• Ability to present clinical data, scientific findings, and complex information in a persuasive manner to a variety of audiences.

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Salary Range:

$175,000.00 - $278,000.00

The annual base salary shown is a national range for this position on a full-time basis and may differ by hiring location. In addition, this position is bonus eligible, and is eligible to be considered for company stock at hire and on an annual basis.

Exact Sciences is proud to offer an employee experience that includes paid time off (including days for vacation, holidays, volunteering, and personal time), paid leave for parents and caregivers, a retirement savings plan, wellness support, and health benefits including medical, prescription drug, dental, and vision coverage. Learn more about our benefits.

Our success relies on the experiences and perspectives of a diverse team, and Exact Sciences fosters a culture where all employees can develop personally and professionally with a sense of respect and belonging. If you require an accommodation, please contact us here.

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